Fluconazole

C. diff Risk

Low

Oral Bioavailability

Excellent

Approximate Cost

Dosing

Loading dose for Candidemia 800 mg IV Serious Infections (e.g. Candidemia, CNS/Endophthalmitis, Coccidioidomycosis) 400-800 mg IV every 24 hr Other indications 100-400 mg IV/PO every 24 hr

General Information

Common Usage

Candida infections both mucocutaneous and invasive - i.e. Candidemia.

Cryptococcus and Coccidioides infections.

Antifungal prophylaxis in immunocompromised.

Drug Monitoring

Lab

  • periodic SCr and LFTs

Clinical

  • Consider QTc monitoring if concomitant drugs affecting the interval or risk factors

  • Hypersensitivity

  • GI effects

  • jaundice

Adverse Effects

  • Drug interactions

  • QTc prolongation

  • Hepatic enzyme abnormalities

  • Rash

  • Alopecia

  • GI upset

Major Interactions

Many via CYP450. Suggest review specific patient medications.

Fluconazole increases levels of phenytoin, cyclosporine, tacrolimus, warfarin, oral hypoglycemics.

Risk when combining with other QTc prolonging medications.

Pharmacology

Antimicrobial class: Triazole antifungal

Pregnancy category: C

Average serum half life: 20 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

Biliary penetration: Therapeutic

CSF penetration: Therapeutic